Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • current chest pain with haemodynamic compromise
  • acute onset chest pain associated with trauma
  • current persistent chest pain, i.e. not intermittent
  • chest pain suspicious of pericarditis or myocarditis, associated with electrocardiogram (ECG) changes or troponin rise
  • suspicion of acute rheumatic fever (ARF) or complications of rheumatic heart disease (RHD) as a cause of chest pain

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Inclusions

  • chest pain primarily on exertion
  • chest pain associated with syncope
  • chest pain with suspected cardiac aetiology
  • chest pain in patients with underlying congenital heart disease

Exclusions

  • recurrent chest pain at rest, without haemodynamic compromise or a history of cardiac disease should be referred to Paediatric Medicine

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • chest pain with other associated features, e.g. syncope

If concerned that clinical condition requires rapid review, contact cardiology registrar – see ‘Contacts for clinical advice’ – to discuss case and facilitate earlier review if required.

Category 2 (appointment clinically indicated within 90 days)

  • chest pain with significant family history, or with known congenital heart defect (CHD)
  • chest pain purely on exertion

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • clinical history including
    • details of relevant signs and symptoms including characteristic, location, and duration of chest pain, onset/triggers, radiation of pain, reproducibility, relieving factors, exercise limitations, change in symptoms over time
    • medical history including gestational history
    • recent illnesses
    • details of any known cardiac conditions
    • family history of cardiac conditions
  • details of any treatments offered and efficacy
  • electrocardiogram (ECG)

Additional information to assist triage categorisation

  • other investigations available, e.g. chest x-ray (CXR)
  • blood investigations, if done

Clinical management advice

Non-exertional chest pain should be referred to Paediatric Medicine

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the referring clinician once the transfer of care has occurred.